الفهرس 
The genus KlebsiellaOnly 14 pages are availabe for public view
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Abstract
Klebsiella pneumoniae is considered the most common nosocomial pathogen in MUCH during the period of the study. Blood stream infection is the most detected nosocomial type of infection among MUCH patients during the period of the study. Nosocomial Klebsiella strains are characterized by high resistance to most used antibacterial agents. The most effective tested antibiotics against K. pneumoniae isolates are imipenem, piperacillin/tazobactam and amikacin, while the least effective antibiotics are ampicillin and amoxicillin/K+ clavulanate. The most effective tested antibiotics against K. oxytoca isolates are imipenem, piperacillin/tazobactam, aztreonam, ceftazidime, cefotaxime and ceftriaxone while the least effective antibiotic is ampicillin. Carbapenem antibiotics and inhibitor protected the third-generation cephalosporins (piperacillin/tazobactam) are the most active antibacterial drugs with respect nosocomial Klebsiella strains investigated. Eleven K. pneumoniae resistotypes are detected in MUCH; resistotype R1 is the most prevalent type, then R2, R4 and R6. The least type is R9. In most nosocomial Klebsiella strains suspicious for production of ESBL (by phenotypic data), gene of class A beta-lactamases (blaCTX-M) is recognized. Preterms, low birth weight, prolonged hospital stay, mechanical ventilation and indwelling devices (such as venous catheters lines and urinary catheters) are the most reported risk factors for the development of Klebsiella infection in MUCH. The 3rd generation cephalosporins are the most associated with Klebsiella infections, and are the most associated with occurrence of ESBL-Kp. Testing for skin and intestinal carriage is a good indicator for detection of ESBL-Kp colonization. Three different biotypes are distributed among K. pneumoniae isolates on the basis of the API 20E; biotype B1 is the most prevalent type. Ninety-four % of K. pneumoniae isolates contain plasmids, producing 4 plasmid patterns (from P1 to P4) and group P5 lacks any plasmid. Phenotypic methods are only screening methods for detection of ESBL in a routine laboratory. The genotypic methods actually help to confirm the genes responsible for ESBL production. Phenotypic methods provide an efficient, rapid differentiation of ESBL in Klebsiella and could be used as a rapid tool for epidemiological studies among ESBL isolates. It is of great importance that mPCR reaction conditions, including DNA template concentration, annealing temperature and the choice of the primer pairs, should be standardized to avoid variations in mPCR patterns. Tracing the sources and revising our MDICU policies were strictly implemented, and helped us to control an outbreak caused by ESBL-Kp and eliminate serious carbapenem resistant K. pneumoniae strain. K. pneumoniae infections in MUCH are caused by a variety of strain genotypes. It can help further efforts to understand the spreading of this bacterium.